Second Stage of Childbirth

This starts when the cervix is fully dilated and ends when the baby is born. This can last from 10 minutes to an hour. It tends to be much slower if the mother has had an epidural or pethidine.

The action and function of the contractions changes for second stage. They now act to push the baby out of the uterus, down through the birth canal and out through the vaginal opening into the big wide world. These contractions are usually experienced as an irresistible urge to push.

Generally in second stage women feel less tired, more alert and have more energy. Once your cervix has dilated, the contractions often become further apart, shorter and the character of the pain changes. Many women find this stage much easier to tolerate than active labour.

If your baby has moved through the pelvis it will now enter the birth canal, and you will feel the baby applying direct pressure on the perineum.

The pressure of the baby’s head against the rectum and pelvic floor activates the stretch receptors in the vaginal walls and causes the uncontrollable urge to push.

If you have a good sense of how to control the pelvic floor muscles, allowing the birth canal to open up, rather than tensing the muscles, this stage is likely to be faster and less painful. You can practise this by doing Kegal exercises regularly during pregnancy. There are also fabulous exercises in the Pink Kit for become very familiar with these muscles and for practicing the relaxation of them. Any time practising and familiarising yourself with your pelvic floor this will be time well spent.

Tips for second stage

Try to keep an upright position . This will assist the baby’s movement down through the birth canal.

Pay attention to the tension in the perineum. Consider how your position is affecting this. If you feel there is too much pressure on the perineum then adjust your position until you feel the pressure is somewhat relived. This may save you a perineal tear or episiotomy.

Relax the pelvic floor. Use your experience with the progressive relaxation exercise to scan the area and relax all pelvic floor muscles.

Resist any urge to tighten up the muscles in your rectum and bowels. If you feel like you are going to move your bowels, just let it happen, you will be helping your baby to come through the birth canal much easier.

Remember that with each contraction, you are bringing your baby closer to birth. You may feel as though you are expending huge amounts of energy with very little result. As a contraction subsides, the baby may move back slightly, but it does gain a little bit of ground each time.

Slow and controlled pushing. Once the baby’s head has crowned you will push very gently and slowly so as to ease it out. If this part of the delivery is slow and controlled then there is less chance of tearing. Your midwife may support the perineum and may apply a warm, wet cloth to help the skin stretch to its fullest.

Once the head is delivered, the face slowly turns to the side it faced while in the uterus, and the shoulders line up to be delivered. The shoulders come out one at a time, first the top shoulder and then the bottom one. The rest of the baby’s body will slip out very easily and quickly and congratulations, you have a newborn baby!

Breathing Techniques for Second-Stage Labor

Avoiding pushing, if necessary .

Sometimes a midwife will encourage you not to push even though you have an uncontrollable urge and feel as though there is nothing that can stop it. There are two main reasons for this. One is to wait for a doctor. If this is the reason you are given, my advice is to ignore the request and go ahead. The doctor being in the room is unlikely to make any positive impact on your birth experience. Conversely, it can increase the likelihood of medical management of second stage which could involve foetal monitoring, often attached to the scalp of the baby, forceps, ventouse, episiotomy and being asked to adopt a position which enables the doctor to see what is happening but is not conducive to an easy birth.

You may need this technique if the cervix is not fully dilated or if you need to be more controlled with pushing in order to prevent tearing.

How to do it

Lift your chin, and arch your back a little.

Either: Breathe deeply, relaxing your body. Or: Pant, blowing lightly. Some people recommend visualizing a feather, and blowing just enough to keep the feather bouncing up and down in the air above your lips.

Benefits

This will keep you from adding your voluntary strength to the involuntary pushing urge. It won’t stop your uterus from pushing, and it won’t take away the urge to push.

Breathing for birth

Breathing the baby out

Breathe in deeply, then on the exhale, gently push downward with your abdominal muscles, while visualizing the baby moving down and out. It may help to grunt or vocalize while exhaling. Continue this pattern through the contraction.

Pushing the baby out

Wait for a contraction, when the urge to push becomes irresistible, then hold your breath for five to seven seconds, while pushing. Then breathe deeply in and out again until the urge to push becomes strong. Repeat this through the contraction.

“Purple” pushing

In the past, some caregivers recommended holding your breath and pushing for as long as possible before taking a breath. However, this can cause a drop in oxygen supply to the baby, and is not recommended.

Positions for second stage labour

Position

Advantages

Disadvantages

– Squatting- Supported squatting

– Uses gravity to assist the baby’s decent through the birth canal.- Continuous, even pressure to dilate the vagina and on the perineum- Encourages baby’s head to continue down rather than retracting during between contractions- The pelvis is open wider- The sacrum can move back out of the way

– There is no pressure on major blood vessels

Tiring- Western women are not used to squatting May feel unstable and awkward- Puts strain on the knees- Difficult to change position

– Side lying

– No pressure on major blood vessels- It’s a comfortable position and can be good for baby’s in a posterior presentation- Can be relieving for backache- Good position to help with rotation of the baby’s head.- Sacrum can move back out of the way, if the baby appears to be ‘stuck’.

– Can create uneven pressure on the pelvic floor- Doesn’t make use of gravity- Difficult for the mother to see what is going on

– Kneeling on all fours

– No pressure of the baby on the mothers back if the baby is in the posterior position- Relives backache- Helps rotation if the baby is in the posterior position- Easy to rock and move the pelvis- No pressure on the sacrum

– Easy access for massage, heat packs and pressure to relive back ache.

– Can slow down a delivery that is happening to quickly, helping it to be more controlled and minimising the chance of perineal and labial trauma.

– Eliminates the use of gravity- Difficult for mother to see what is happening May slow down delivery

– Semi-recumbent (half lying/half sitting)

– Mother can watch the birth with a mirror- Gravity assists a little bit in the decent of the baby- Legs can be supported- Easy to rest between contractions- This is a commonly used position because it is easiest for medical staff to see what is happening.

– Movement of the sacrum is restricted by the bed- Puts an uneven pressure on the perineum, which may promote the need for an episiotomy.